Provider Demographics
NPI:1386762565
Name:COWGER, JENNIFER ANN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:COWGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:COWGER
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD # K14
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-2966
Mailing Address - Fax:313-916-8799
Practice Address - Street 1:2799 W GRAND BLVD # K14
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2966
Practice Address - Fax:313-916-8799
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083365207RA0001X, 207RA0000X
IN01072208A207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386762565Medicaid
IN201147430Medicaid
IN940550088Medicare PIN